Clinical Neuroscience

[Serum level tests to guide modern antiepileptic treatment]

RAJNA Péter1, SZTANISZLÁV Dániel1, BARACZKA Krisztina2

MARCH 01, 1985

Clinical Neuroscience - 1985;38(03)

[Based on literature data and the experience of measurements in two of the most relevant laboratories in this field, the authors analyze the usefulness of antiepileptic serum level determinations in guiding antiepileptic treatment. The importance of the kinetic approach is briefly outlined and the basic pharmacokinetic metrics are presented. Using these, they outline the rules for modern drug dosing and drug administration strategies. They point out the possibility of individualized, targeted treatment and the rationale of monotherapy as opposed to the previous polytherapeutic approach. The importance of patient cooperation in treatment and the factors influencing it are stressed. The indications for serum level tests, the basic technical requirements, and the limits of measurement are discussed. In addition to emphasizing the primacy of the clinical picture, the measurement of serum levels of antiepileptic drugs is considered essential in order to better exploit the effects of the drugs.]

AFFILIATIONS

  1. Országos Ideg- és Elmegyógyászati Intézet
  2. Semmelweis Orvostudományi Egyetem Psychiatriai Klinika

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[Treatment of intracranial saccular aneurysms]

TÓTH-DARU P., PERTUISET B.

[In this communication, we report the experience gained in the surgery of saccular aneurysms of the brain, the diagnostic and therapeutic methods used, and in particular the programming of the time of surgery, at the Neurosurgery Clinic of the Pitié Hospital in Paris. From 1970 to 1983, the medical history of 545 patients with saccular aneurysms operated on was reviewed. The conclusions and findings of this report are based on these. ]

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[The diagnostic process for psychiatrists experimental approach and comparison]

BARTKÓ György, BÉKÉSY Marian, KIS András Ákos, TOLNAI György

[The authors have attempted to approach the diagnostic process of 13 psychiatrists using two theoretical constructs - the individual diagnosis schema and the internalized nosological theory - and to compare them using mathematical statistical methods. The results justify the necessity of separating the two concepts and point to the need to pay more attention to implicit theories of analysis that differ significantly between individuals if the reliability of diagnoses is to be increased. It is concluded that treatment preference is only partially and marginally influenced by the diagnostic process and that therapeutic decisions are predominantly determined by other considerations. ]

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[Changes in Rosetta markers in peripheral blood of schizophrenic patients]

DEMETER József, BODOLAY Edit, SURÁNYI Péter, GÁL Róza, SZEGEDI Gyula

[The authors investigated the distribution of lymphocytes in the peripheral blood of schizophrenic patients. They observed a high degree of T lymphocytopenia in untreated forms of the disease and during acute relapses in treated patients. In addition to a decrease in T cell count, the proportion of lymphocyte subpopulations carrying IgG Fc receptor and histamine receptor increased. A moderate increase in B cell numbers was found. No appreciable differences were found in the distribution of peripheral blood lymphocytes between different types of schizophrenia.]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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